Back to School and Your Child's Eyes

It's that time of year again! This is the best time to bring your children in for a comprehensive eye examination. The kids are available and there is no better way to get them ready for the new school year. You may be thinking: "Billy sees things that I don't see and he has always passed the school screening by the school nurse or pediatrician". The truth of the matter is that many conditions can be missed by a simple screening, especially in children. High degrees of hyperopia and well as moderate amounts of astigmatism can be completely missed. In addition, a simple screening does not evaluate how your child uses his or her eyes together. It is very important that children have adequate tracking skills as this is required to read efficiently and increase reading comprehension. Children should also be tested for color vision and depth perception. They should be tested for both their distance vision and their near vision. If they have not had their eyes dilated, this is also recommended. So, bring your children in for their yearly eye examination and while you are at it, get your eyes tested too.

Why Do Patients Need Computer Glasses?

I am constantly asked about computer vision problems at the office. This is due, of course, to the amount of time that we all spend looking at a computer screen. There are lots of issues that patients have when looking at a computer screen. The many issues relate primarily to dryness, eye muscle problems, and focusing problems. If a patient has dry eyes to begin with, the problem increases when looking at a computer screen due to the fact that there is a significant decrease in the blink rate when lookng at the screen. I have discussed dry eyes in a previous entry in my blog. Please review that entry for some tips to help with dry eyes. Eye muscle problems can also make it difficult to look at a computer screen for an extended period of time, as this requires that both eyes be pointing at a fixed distance...arm's length for example....for an extended period of time. If the eyes cannot point with comfort at this distance they become tired and this can contribute to headaches and blurred vision and can have a negative effect upon work place performance. Eye exercises can be prescribed for patients that have this problem. There are certain instances where special lens treatments, called prisms, can help as well. These treatments can be incorporated into computer glasses as needed. Finally, there is all the issues associated with focusing problems. Most of these issues relate to the difficulty that patients have with near point focusing associated with the aging process. All of us eventually need help focusing our eyes for near. Regular bifocals don't work well for the computer screen unless we are working on lap tops. With lap tops we look down to see. Here a normal bifocal can often work. With desk top screens a regular bifocal is not the best solution because the patient will have to lift up their chin to look out of the bottom portion of the lens where the bifocal part is. In addition, the bifocal portion is normally set in closer..say about 16 inches.. for normal text viewing. The average computer screen is set out farther at about 26 inches. To view the screen with a regular bifocal, the patient would have to both lift up their chin and lean in to see the screen. This creates both eyestrain and neck strain. To avoid this problem, we can either make reading glasses that focus farther out at the 26 inch distance or design a custom bifocal that provides clear viewing through the top part at about 26 inches and then make the bottom more magnified for text viewing. There is a new computer bifocal available now that also allows the patient to be able to get some distance viewing out of the top part of the lenses when necessary.

All of these products discussed above function better when they are treated with a glare free coating. The only way to properly design the necessary type of computer lenses that are best for each individual patient is for the patient to have a comprehensive eye examination along with a detailed history that allows the doctor to discover exactly how the patient functions in their work and at home computer environments.

If the reader has any additional questions or comments about computer eyeglasses please contact me at jon@villageeyes.com.

Keratoconus Treatment: Contact Lenses, Corneal Cross Linking, and Common Sense

Keratoconus is an eye disease in which the cornea of the eye becomes thin and bulges forward causing distortion to the optics of the eye. The cornea of the eye is the most powerful light bending surface of the eye and distortion to this surface can have a devastating effect on the clarity of vision. There has been a great deal of research into the causes of keratoconus and it's treatment. The purpose of this post is to discuss the disease, its various stages and the treatment options that are available.

In the early stages of keratoconus treatment can be relatively simple. When there is not a great deal of distortion to the cornea, eyeglasses and soft contact lenses can often provide good vision. As the disease progresses there is a decrease in what is known as "best corrected vision". This means that as the cornea becomes more irregular, eyeglasses and soft contact lenses may begin to no longer afford the patient the sharpenss to their vision that they had previously enjoyed. Different methods need to be employed to restore or to help capture a sharper image on the retina (the back of the eye). Here is an analogy: Imagine that you have a brand new camera. In the camera you have excellent quality film. At first the camera takes great pictures. Slowly, over time, you notice that the pictures are becoming fuzzy and not clear. The film is great, in this example, but a defect has occurred to the front part of the lens in the camera. The surface had become irregular, perhaps because the lens became scratched. Because of this irregular surface on the front of the camera, the images are no longer clear. This is what happens to the human eye when the cornea becomes distorted. In the human eye, the surface of the cornea actually becomes irregular and uneven....not scratched as in the camera analogy....but this irregularity distorts the images that are formed on the retina (the retina is the back of the eye that is similar to the film in a camera in this example).

As the cornea becomes more and more distorted, something has to be done to improve the surface quality of the cornea. Eyeglasses can still be worn, but the clarity of the vision becomes poorer and poorer. To restore this optical quality to the eye, rigid contact lenses are used. The reason that rigid contact lenses improve the quality of the image on the retina is that they become a new front surface for the eye. They are made from a rigid material and when placed on the eye, the area between the back surface of the rigid lens and the front surface of the cornea (which is now irregular and distorted) fills in with a patient's own tears. Optically speaking, the new front surface of the cornea is now the front surface of the rigid contact lens. Because it is smooth and regular it erases the distortion present on the natural corneal surface and light passes through to the retina causing a sharp and defined image to be formed on the retina, thereby returning sharp vision to the eye.

How are rigid contact lenses fitted to the cornea in keratoconus? This is a very complicated subject. Depending upon the degree of distortion to the cornea different types of rigid contact lenses can be used to improve the vision. First, the degree of distortion of the eye is measured by devices that can map or determine the shape of the corneal surface. Then the eye doctor or contact lens fitter has to try different lenses on the eye to determine which type of lens will best fit the cornea and the surrounding tissues. To do this, the eye doctor or contact lens fitter has to try on many different types of lenses. To be successful, a large inventory of diagnostic lenses must be available. In keratoconus contact lens fitting there is no such thing as one size fits all. Every cornea is different. Sometimes small contact lens designs work and sometimes larger lenses need to be employed. It is common to try on lenses from many different manufacturers before settling upon a lens design that is correct for the individual patient. It is important for the patient to understand that the fitting of contact lenses for keratoconus is a process. It requires many visits over a period of time. Even after the best fit and vision is determined by the contact lens fitter, the lens needs to be custom ordered. Once the lenses come back to the office and are verified to be correct they then need to be seen on the patient's eyes. The quality of the fit is determined by using a special diagnostic dye that will spread through the patient's tears and collect behind the contact lens. (This same dye is used in the initial fitting process as well.) The dye will glow when exposed to a special light that the doctor will shine on the eye to determine the best fit. By observing how the tears collect behind the lens the doctor can assess the quality of the fit. Once it is determined that the fit is proper, the vision is measured as well. If everything goes according to plan, both the vision and the fit are what was expected. The patient is trained on the care and handling of the products and is asked to begin wearing the lenses on a schedule that gradually increases the wearing time until the patient is able to work up to a full day of wear. After using the lenses for a period of time the patient is asked to return to further assess the quality of both the fit and the vision. It is common for both the fit and the power of the lenses to be modified on the first follow up visit. This may not be necessary, but it is a common scenario as the lenses can "settle" on the eye after using them for awhile requiring a modification in the fit of the lenses. New lenses are then ordered. It is helpful if the fitter or the doctor has the ability to modify the lenses in the office. If this is possible, many of the minor adjustments can be done on the premises rather than off site. This makes is easier to "fine tune" the fit for the patient.

After reading all of the above information it is easier to understand that the fitting of contact lenses for keratoconus is indeed a process. What should the keratoconus patient look for when choosing a doctor or contact lens fitter to help them with obtaining properly fitting contact lenses?
Here are some suggestions: 1. Make sure the person fitting the lenses has lots of experience in fitting lenses specifically for keratoconus. 2. Make sure the fitter has many different fitting sets....remember that one size does not fit all eyes. 3. If possible, make sure the fitter can do contact lens modification is the office when appropriate. 4. Make sure that you are comfortable with the fitter and the office. You will be spending quite of bit of time at the office. It is no fun being in an office where you do not feel welcome.

Keratoconus can take different forms. While it is supposed to be a condition in which both eyes are involved, this is not always the case. Sometimes, only one eye is affected. Some cases continue to deteriorate, requiring refitting of the contact lenses. Some cases deteriorate to the degree that the cornea needs to be replaced. This is called a corneal transplant. Not all cases get to this point. Some cases never progress to the point where contact rigid contact lenses are required. Corneal transplant surgery is getting better all the time. There are many excellent surgeons that can help patients when their eyes get to the point that the cornea needs to be replaced. When a transplant is needed, this is due to either scarring that develops to the surface of the cornea or to distortion that becomes so great that contact lenses can no longer be successfully fitted. (Corneal translplant surgery is an entirely different discussion that I am not going to discuss extensively in this post.) Once the surgery is completed, contact lenses again need to be employed to best allow the patient to achieve good quality vision. If keratoconus contact lens fitting is difficult, post surgical contact lens fitting can be even more so. The good news is that the doctors that help patients with keratoconus contact lens fitting are also experts, in many cases, at fitting lenses to the cornea post surgically. Again, different lenses need to be employed to best correct the vision.

Are there any things that can be done to improve the condition of the cornea as the keratoconus progresses? The answer is yes. Here are some suggestion: Keratoconus has been associated with eye rubbing and eye allergies. Don't rub your eyes!!! It is believed that eye rubbing can help to distort and thin the corneal surface. To help you with not rubbing your eyes you can use eye drops that lessen the symptoms of eye allergies. Some of these are available over the counter and some need to be prescribed. A good over the counter anti-histamine eye drop is "Zaditor". Cool compresses help. There is also some evidence that using cooled tea bags and even cucumber slices help to calm the symptoms of eye itching. Keratoconus can be associated with dry eyes. There are a medications that can help with dry eyes that your doctor can prescribe. There is also a procedure called punctal occlusion that can be done in the doctor's office to help you capture your own tears before they drain from the eyes. Tear quality is very important too. Many patients have poor tear quality as well as keratoconus. Tear quality needs to be improved to make sure that contact lens wear is as comfortable as possible. There is increasing evidence that a new procedure called corneal cross linking can help to strengthen the cornea. In this procedure, the top surface of the cornea is removed and the eye is exposed to specially formulated Ribovlafin (vitamin B2) eye drops. The eye is then exposed to ultraviolet light for a short period of time. This procedure makes the collagen bonds in the cornea stronger and can help to stabilize the condition. The eye is patched with a bandage contact lens for a period of time until the top surface of the cornea can normalize. Once the top surface regrows, the bandage lens can be removed. This procedure is undergoing clinical trials here in the United States. Excellent results have been reported in Europe where the procedure originated. Evidence shows that to be successful the top surface of the cornea must be removed to allow proper penetration of the Riboflavin eye drops. In addition to this treament, it is possible to improve the cornea surface quality, once it no longer will support contact lenses due to irregularity, with the addition of what are known as "Intacts". These are small plastic inserts that are placed into the cornea to make the surface more regular. There have been positive reports from this procedure. This procedure is considered when the eye will no longer accept custom contact lenses due to increasing irregularity. Once the "Intacts" are inserted, contact lenses again need to be fitted to the eye. All of the above discussion regarding fitting of the contact lenses again applies to the refitting after the insertion of the "Intacts".

Here are some of the lenses that are used to fit corneas that have keratoconus: Rose K, Dyna Z Intralimbal, Macrolens, Acuity One, SI02, Soper, Synergeyes KC and Clear Kone and many more. In addition, sometimes "piggyback" contact lenses can be employed. This involves placing a soft contact lens on the eye first and then placing a rigid lens on top of it. This can be successful in many cases. It can be done with what are known as silicone hydrogel soft contact lenses and any variety of rigid lens placed over the soft contact lens. There are aslo available special soft contact lenses that have a small "cut out" in the center to allow the rigid lens to seat itself in the center of the lens and remain stable. Your contact lens fitter probably has some favorites to work with, but it is extremely important to know that it takes many different types of lenses in diagnostic sets at the fitter's office to best asses the proper fit for each patient.

I hope this discussion will be helpful to the keratoconus patient in learning the many different approaches to fitting contact lenses to the keratoconic cornea. If you have any questions, I may be emailed at jon@villageeyes.com.

Change Your Eye Color......Maybe?

I attended a very interesting lecture and presentation last night that I want to share with everyone. The presentation was through the offices of Dr. Kerry Assil, M.D. Dr. Assil is an ophthalmologist and corneal specialist that I have co-managed several cases with over the years. The highlight of the presentation was two live surgeries that were performed by Dr. Assil. What made these lectures especially interesting was that they covered some topics that I had never seen before. The most interesting topic was the removal of a silicone colored disc that was surgically implanted in a patient's eyes by an ophthalmologist in the country of Panama. The patient that had the surgery originally had these colored silicone plastic discs implanted into his eyes to change his eye color. His eyes are originally brown and he wanted them to look green. The lenses are kind of shapped like a "life saver candy" with a colored ring and a hole in the center so light can enter the eye. I must say the the cosmetic effect of the lens on the eye prior to surgery was very natural looking. The eye actually did look green and very realistic. Here is the problem: The artificial iris that was placed into the eye sits in front of the natural iris and covers up the natural eye color. This would be OK except that the artificial iris rubs against the natural iris creating loose pigment particles that plug up the eyes natural drainage mechanism. In addition, the artificial iris rubs against the front surface of the cornea causing the cells there to be decompensated. This can cause the patient to develop corneal swelling and eventually require a corneal transplant. Not only this, but the patient can be more prone to developing cataracts at a much earlier date as well as chronic inflammation to the eyes.

The surgery proceeded without complication and after the procedure the patient was brought before the audience and questions were asked. The overall upshot of the questioning pointed to the fact that it is very easy for consumers to see something such as a cosmetic procedure as a safe and easy surgery when real risks and dangers can accompany the surgery. This can apply to everything from eye color change to weight loss procedures like the "lap band". All other things being equal, the best thing that patients can do is research. Ask other professionals in the field what they think of a particular procedure if you are considering it. Get a second opinion. If there is only one doctor doing the procedure and the doctor is in a country far away from where you live, how are you going to deal with possible problems that may arise.

There are many safe and effective ways to change eye color using tried and true products like cosmetic contact lenses. I think this patient has learned a very valuable lesson from this experience.

Post Surgical Contact Lens Fitting

Post surgical contact lens fitting can apply to a number of different situations: 1. There was a trauma to the eye that required surgery to the cornea requiring custom contact lens fitting to provide the best vision for the patient. 2. The patient had a corneal disease such as keratoconus) that required a corneal transplant and thereafter contact lenses needed to be fitted to obtain the best possible vision. 3. The patient had refractive surgery with an unsatisfactory outcome. To provide the patient with the best possible vision, contact lenses need to be fitted. This can apply to both Lasik and Radial Keratotomy.

Post surgical contact lens fitting is probably the most complicated form of contact lens fitting. In many cases the cornea is so irregular that traditional contact lenses cannot be used. Doctors use custom types of contact lenses that are typically larger than most contact lens designs. While most patients that wear traditional contact lenses often wear soft contact lenses, the majority of lenses prescribed for post surgical applications are made with rigid polymers or from special hybrid designs that incorporate both rigid and soft materials in the product. It is important that the doctor has a variety of different fitting sets and materials on hand so the best possible fit can be achieved. In the case of fitting these products, the patient needs to understand that the fitting is a process. It often takes many visits over a period of time to come up with the best product for the individual patient.

Once fitted these contact lenses often allow patients to again have very good usable and sometimes excellent vision. This allows them to return to doing normal activities that were difficult and often impossible prior to the fitting of the lenses. If you have any questions about custom contact lens fitting for post surgical corneas, please email me at jon@villageeyes.com.

Bifocal And Multifocal Contact Lenses

Bifocal or multifocal contact lenses have come a long way in the last few years. The first attempts to make these products were not very good. They would work for some patients but this was the exception rather than the rule. Today, due to research and new product development, there are a multitude of designs from many different manufacturers. The lenses come in designs for both soft and rigid gas permeable polymers. I have had success with both the rigid and the soft products. In general, the vision can often be a little sharper with rigid gas permeable contact lens multifocals and bifocals than it is with soft lens bifocals and multifocals. While this does not universally apply, the reason it does frequently apply is due to the better optics provided by the rigid lens material.

Most of the fits that are performed today by doctors that fit these products are in the soft lens materials. Patients believe that rigid lenses are more difficult to wear and adjust to. While there is a little bit more adaptation with rigid lenses, the optics provided make the adaptation worth while for many patients. Once adapted, rigid lenses are very similar in comfort to soft lenses. I must say, however, that the soft lens products have improved significantly so that most patients find there vision to be satisfactory for most activities.

How do doctors determine which product is best for a patient? This is based upon the nature of the patient's prescription, the demands of the patient (how much and what type of close work the patient does), the work environment, the health of the eyes, the amount of moisture in the eyes, and the amount of time the patient wants to use the particular product.

The fitting of contact lenses, especially custom type products like bifocals and multifocals, has to be considered a process. This means that it often takes several types of lenses over a period of time to satisfy a patient's needs. Luckily, the contact lens manufacturers are aware of this and they will provide the doctor with diagnostic lenses to help the patient and the doctor to find the best lenses for the individual. Doctors charge a fitting fee to cover the cost of the time involved to find the best product for the individual patient. The fitting fee covers the time and effort required to evaluate the products and come up with the best options for the patient.

If you are interested in obtaining multifocal or bifocal contact lenses, make sure that you see a doctor that has lots of experience with the fitting of these products. They are more complicated and a positive outcome will be more likely achieved with an experienced eye doctor. If you have any questions, please contact me by email at jon@villageeyes.com.

Eyecare Humor

If you have not seen Brian Regan's take on his visit to his eye doctor you will certainly enjoy this. Here is the link:www.youtube.com/watch?v=v8GMFkc3iSA

Choose your eye doctor the best way. Do your homework!

There is no substitute for homework. By this, I mean that if you want to find a good eye doctor, dentist, podiatrist, physician, chiropractor, psychologist, hygienist, physical therapist or any health care professional you have to do research. This does not mean that you cannot trust the recommendation of your friends, family and colleagues. A personal recommendation is one of the best ways to find a health care professional. I would make sure that the person referring you has personal experience of the specific health care professional that you are being referred to. If the health care professional has a web site, you should check that out. Verify the education and experience of the doctor. Make sure that the description of what is available matches what you are looking for. In general, the more experience that a doctor has the greater the possibility that you will have a positive outcome. Doctors that have been in practice for a long time generally are successful because they satisfy their patients needs. This is not always the case, but in general it is true. Another good indication is a referral from another doctor. If lots of health care professionals use a particular doctor the chances are excellent that you will be well taken care of. It is also possible to go to the "Department of Consumer Affairs" in your local state and find if there are any complaints against the doctor. In addition, you can visit a site like "Yelp" and look at the reviews that are listed for the particular professional. You can also check reviews on "Google" and other sources.

A word about reviews: There are very few doctors that have perfect reviews. This is because doctors are people and they deal with events in the real world. The real world is not perfect, although we all want it to be. If the majority of reviews that an individual doctor has are positive, I feel that it can be assumed that the doctor is satisfying most of his patients. This will apply, especially, if there are mostly positive reviews more recently and only a few negative reviews from quite a ways back. In addition, readers have to realize that the negativity of the review may pertain to the staff and not the doctor. The doctor may be terrific but if the staff is not well trained in patient care and satisfaction, this will still not bode well for the doctor. A negative review based upon staff issues is just as valid as any other negative review. The first impression a patient has regarding a particular office is usually the telephone contact. Many things can have a negative impact upon a patient's impression: How long did it take for the receptionist to pick up the phone? Was the patient immediately put on hold and not gotten back to in a reasonable amount of time? Was the person representing the doctor friendly and helpful? Once in the office for the appointment, was the patient attended to in a timely manner? How long did the patient have to wait until being seen by the doctor? What kind of condition was the office in? Were the magazines up to date? Were the bathrooms clean? All of these questions can have a dramatic effect on a patient's impression of a particular doctor's office AND THE PATIENT HAS NOT EVEN SEEN THE DOCTOR YET!

What about the doctor? Was the doctor friendly? Did the doctor answer the patient's questions? Were the patient's reasons for being there addressed? Were follow up visits scheduled when necessary? Basically, did the patient get the overall impression that the doctor and staff were happy that the patient had come to them for professional services?

If the overall impression is negative, the office probably does deserve a negative review. I also feel that it is important for doctors to poll their patients to make sure that the overall impression of patients is
positive. Doctors want their patients to be satisfied. A problem occurs when feedback is not monitored by the doctor and staff. I think the most valuable thing that a patient can do for an office, if they have a negative experience, is to let the doctor know. It is much better for the doctor to know about the problem so the problem can be addressed and solved rather than the patient just leaving and going to another office and telling everyone about their negative experience. If after offering constructive criticism the patient still feels that their concerns are not being addressed, it is definitely time to find another doctor.

So, the bottom line is: 1. do your homework 2. be open minded 3. if you are not satisfied, let the doctor know 4. If you are happy with the services of the doctor and staff, tell others so they too can have a positive experience 5. Offer your own review of the office

Good luck with your professional relationships. If you have any questions or comments, please contact me through my listed email on the blog.

How to find a lost contact lens and how to prevent contact lens loss

Losing a contact lens is something that has happened to all contact lens wering patients as well as to eye doctors who regularly dispense them. I confess that it is easier to lose a rigid gas permeable contact lens than a soft lens, but soft lenses can disappear from view as well. In the soft lens category, the toric lenses are the easiest to lose due to the fact that they are frequently thicker on one side making it more likely that the lens will slip off of your finger when trying to insert it.

So, how can you prevent the loss of a contact lens? First of all, if you are working over a sink make sure that the drain is closed. If you have a sink that does not have a drain stopper, place a washcloth over the drain to prevent the lens from going down the drain. If you do lose a contact lens down the drain, immediately turn off the water. You can take apart the pipes below the drain or call a plumber to do this. It is not very complicated. Have a bucket ready to place under the area that you are working in because once you disconnect the pipes water will come out as well as your contact lens. (Note: In our new era of disposable contact lenses the loss of one lens is not quite the emergency that it was when we did not have disposable lenses. Lenses are still being prescribed that are either not quite as disposable or simply not disposable, such as rigid gas permeable lenses. These lenses can be quite expensive and it is definitely worth it to make an effort not to lose these products.) Getting back to retrieving the contact lens, once it comes out check it out to make sure it is not scratched or damaged. Clean and disinfect it overnight and it should be good to go the next day. If the lens looks suspicious or you are not sure about its condition, please have your eye doctor inspect it.

If the lens falls on the floor, this is the best technique for finding it: Get a flashlight and turn off the lights in the room. Be careful where you step because if you step on the lens it will most likely be history. Get down low to the floor and shine the flashlight beam across the surface of the floor making sure your eyes are as close to the floor as possible. Using this technique the lens will be illuminated and will stand out so you can find it. Again, inspect, clean and disinfect it prior to putting it back in your eye. If the lens cannot be found on the floor it is most likely stuck on a vertical surface, on top of something nearby or in your clothing or it could even possibly have found its way under your clothing. You can use the side lighting technique I have described above for vertical surfaces as well. I have found contact lenses in pockets, cuffs, etc., and I have had my female patients actually report having found lost lenses in their bras. So check everywhere the lens might actually have gone.

A good technique to help prevent loss is to work over a desk or horizontal surface and to put down a white towel. Make sure you have good lighting. If you drop the lens it will fall on the (hopefully) clean towel surface and it will be unlikely to bounce off. Have a bottle of saline/disinfecting solution nearby for rinsing. If you are having problems with insertion and removal, schedule a tune up visit with your doctor for more recommendations on the best techniques for insertion and removal.

What do you do if you lose the contact lens in your eye? First of all, don't panic. The lens cannot work its way up into your brain because the area around the eye is an enclosed environment. Check your vision. If you can see, it is still on your eye. If you cannot see, it has to be above, below or on the sides. Look in the mirror and try to see it. If you can and it is a soft lens simply pull it out. If you cannot see it the lens can sometimes get folded in half and sort of lodge itself up under your upper eyelid. You can close your eyes and look down and use your fingers to massage the lens to either side where you can see it and remove it. If it is a rigid lens, do the same thing. You can either push the rigid lens back on the cornea and remove it or you can use a small suction cup...available from your eye doctor...to remove it. If all else fails, call your eye doctor and schedule an office visit to have it removed.

Lastly, there is a product available that is made of soft plastic that can be used to cover the drain opening. The center has a raised top that sits over the drain opening and there are multiple small holes so that water can go down the drain but your contact lens cannot. If you are interested in information about this product, please contact me at my email address. If you have any additional questions about the condition of lenses that have been dropped and possibly have become damaged, make sure your eye doctor inspects the lens before you use it again.

Eye Makeup Tips and Eyelash Growth: An Eye Doctor's Perspective

I am asked frequently about eye makeup at my office in Westwood Village, California. Patients have questions about the type to use, when and how to use it, when to change it, etc. I have had patients upset with me when they develop an eye infection and I tell them they have to discard their makeup. I understand that makeup can be expensive, but in the case of an eye infection it is not worth it to keep using the makeup after it has been contaminated. There is a "new kid on the block" as far as eyelashes growth goes. Here I am referring to "Latisse". This is a product that is now available to actually increase eyelash length. It is a derivative of a product that has been used to treat glaucoma. It has been found that a side effect of this medication is the growth of a patient's eyelashes. The product has been reformulated to specifically increase the length of eyelashes without having the theraputic effect of lowering the intraocular pressure. Certain side effects can accompany the usage of this product: It can darken the iris and it can rarely cause a darkening of the tissue at the base of the lashes. Questions regarding this new product can be addressed to your eye doctor.

Below is an excellent article from "The Eye Digest" at the University of Illinois Eye and Ear Infirmary. It does an excellent job of describing the in's and out's of eye makeup usage.

Since ancient history, women have worn cosmetics to enhance the appearance of their eyes. Most people who wear eye makeup never have a problem related to makeup use. Some women can, however, develop an allergic reaction, infection or injury of the eye or eyelids. These problems can range from minor annoyance, such as tearing of the eyes, to visual loss or even blindness.


Who has problems with eye makeup?
Contact lens wearers and people with allergies or sensitive skin are more likely to confront problems while using eye cosmetics. However, anyone who wears eye makeup should be aware of basic safety tips to help prevent injury or infection. (See safety tips below.)

What problems can occur?
The most serious problem related to eye make-up involves injury to the cornea (the clear front surface of the eye), often during application of the cosmetic. A mascara or eyeliner wand or a fingernail can scratch the cornea (corneal abrasion). Occasionally a corneal abrasion can become infected leading to a potentially blinding corneal ulcer. Corneal injuries are usually painful and always require prompt medical attention.

All eye cosmetics contain preservatives that retard the growth of bacteria in the makeup. However, if certain precautions are not taken, bacteria from the skin can still grow in the cosmetic after use. (See safety tips below.) Some women develop frequent conjunctivitis (infection of the outer part of the eyeball) due to contamination of their eye cosmetic or makeup applicator.

Although preservatives partly protect against infection, they can irritate the eye and skin in some sensitive persons. Additionally, some people may be allergic to fragrances or other ingredients in some cosmetics, such as Rosin (also called colophony), nickel and lanolin. They may develop tearing, itching and redness of the eyes, or swelling and flaking of the eyelids. Allergic persons may need to try different hypoallergenic products until they find one that is safe for them. For instance, pencil eyeliner and powder eye shadow may cause less irritation than liquid liner and liquid shadow.

Also, if some women are sensitive to water-proof mascara, they may have less difficulty with a water-based product (one that washes off with water). However, if they continue to have problems after switching products, the cause may not be an allergy. The problems could be caused by blepharitis, a chronic inflammation of the eyelids, which the eye doctor can diagnose.

What are some safety tips to using eye cosmetics?

• Apply eyeliner outside the lash line (away from the eye) to avoid direct contact of the cosmetic with the eye. There also will be less chance that the liner will flake off into the eye.

• Keep eyeliner pencils sharpened so that the rough wood casing won't scratch the eye or eyelid. As the pencil becomes old, the liner tip becomes stiff, requiring more pressure to apply. When this happens, replace the pencil with a new one

• Replace cosmetics every six months (more often if you wear contact lenses) to avoid excess contamination with skin bacteria.

• Never use an old applicator in a fresh cosmetic product. The applicator will transfer bacteria to the new cosmetic.

• After any eye infection, such as conjunctivitis, buy fresh eye makeup.

• Even though eye makeup removers are designed for use around the eye, they can irritate the eye. Apply them carefully to the eyelid and avoid getting them in your eye.

• Never apply eye makeup while in a moving vehicle. You may accidentally poke the applicator into the eye during a sudden bump or stop.

• Never use saliva to thin old or clumped makeup or to wet a mascara wand. Your saliva contains bacteria from your mouth.

• Do not use a safety pin or other sharp instrument to tease apart clumped eyelashes.

• If you use an eyelash curler, make sure the rubber is soft, not stiff and cracking. Always use the curler before applying mascara. Persons allergic to nickel should not use an eyelash curler, as the metal frame contains pickle.

• Do not share your eye cosmetics with others. Each person has different skin bacteria. If you contaminate your cosmetics with another person's bacteria, you may get an infection.

• When at a store cosmetics counter, be sure the cosmetics demonstrator uses fresh applicators and does not let a used sample product come into direct contact with you.

• Check with your eye doctor if you think you have a cosmetic-related eye problem.

Are there special concerns for contact lens wearers?
People who wear contact lenses are prone to corneal abrasions or corneal ulcers if they have poorly fitting lenses or get dust specks under the lens. In addition, they may contaminate their lenses with the oils, residues and possible bacteria found in cosmetics. Some simple precautions can minimize the chance of contamination:

• Insert contact lenses before applying makeup and take them out prior to removing makeup. Always wash your hands before touching your contact lenses.

• Apply makeup less heavily close to the eye. For example, mascara should be applied only to the tip of the eyelashes.

• Buy fresh eye makeup products every three to four months.

• Avoid using cosmetics such as lash-building or thickening mascara and metallic-sheen eye shadows, which contain particles that can flake off into the eye. If these particles get between the contact lens and corneal surface, they can scratch the cornea and may lead to infection.

• Do not wear eye cosmetics during a contact lens fitting examination. (All contact lens wearers should have yearly eye exams to assure the health of the cornea and proper fit of the lenses.)

• If you hurt your eye while applying cosmetics, it is important that an eye doctor examine you. Sometimes a minor injury can become serious without proper medical attention. If possible, take the applicator and cosmetic with you to the doctor so that the products may undergo tests for bacteria. Follow your doctor's advice on when to resume wearing eye makeup.

When can I wear makeup after eye surgery?
Your surgeon will give you instructions about the use of cosmetics before and after eye surgery. In order to avoid bacterial contamination, you should stop wearing makeup a few days before surgery. Depending on the type of surgery, you may be able to resume makeup use after only a few days. Ask your physician. Water-based products will require less rubbing to remove and are gentler on an eye healing from surgery.

Used properly, cosmetics can safely enhance the beauty of your eyes. Consult your eye doctor if you have further questions about the safe use of eye cosmetics.

Emergency Eye Care

Here are some examples of an emergency eye care event. It's a Sunday and you are working in the garden and you brush up against a bush and scratch your cornea. This is a very painful event and it requires attention ASAP. You have options: 1. You could call your eye doctor 2. You could go to the "emergency room" at the nearest hospital 3. You could go to an "urgency care center" 4. You could hope for the best and just use artificial tears until Monday rolls around.

The best thing to do in this situation is to seek professional treatment. If you go to an urgency care center or an emergency room, make sure that they have what is called a "slit lamp". This is a high powered microscope that allows the doctor to visualize the front part of the eye with a very high degree of magnification. With this tool the doctor can see the exact cause of the abrasion, whether any material remains embedded in the corneal tissue, and can determine the best approach for treatment. If any debris or a foreign body is in the cornea, this must be removed for proper healing to occur. The doctor will use an anesthetic eye drop and remove the object or debris.

The treatment usually involves prescribing an antibiotic eyedrop or ointment, a pain reliever and resting the eyes for a few days. The best way to find a doctor that provides emergency eye care is to first try your regular eye doctor. If your regular eye doctor is not available and you cannot get a reference to a doctor that is available, look up doctors that provide emergency eyecare using an internet search engine such as "Google" or "Yahoo". In most cases, it will be significantly less expensive to seek out an individual eye doctor for treatment rather than to go to an emergency room. The chances are that you will be seen very quickly and the problem will be attended to. There is normally a premium charged for after hours care, but it is still significantly less expensive than going to a hospital emergency room in most situations. Make sure to ask if the doctor takes your insurance so that you can be reimbursed for a portion of the cost of the visit.

It is possible that the problem is so serious that it does require the care of an eye specialist. If this is the case, the eye doctor that sees you can refer you to the proper facility for further treatment when necessary. This may be the case if a caustic chemical gets in the eye. If this is the case, you should flush the eyes out with lots of water and seek treatment ASAP. Other eye emergencies or urgencies involve eye infections, iritis, pain in the eye, loss of vision, visual disturbances, increases in floaters, sudden blurred vision and light flashes.

The best way to deal with these issues is to first call your regular eye doctor. Your regular eye doctor may be able to see you to take care of the problem or to refer you to someone that is available to help you. If not, try the above mentioned internet search engines or go the the emergency room at the nearest hospital. You may have to wait longer, but they will make sure that you are treated for the particular problem.

If you have any questions about the above information, please contact me at jon@villageeyes.com or review the information contained in our website, www.villageeyes.com.

Corneal Abrasions and Scratched Corneas

Corneal abrasions and scratched corneas can be extremely painful. The reason that they are so painful is that there are nerves just under the surface of the cornea that become sensitized once the top layer of the cornea (called the epithelium) is removed. These cells on the top of the cornea are very soft and pliable and the layer is very thin. They can easily be removed by a sharp object rubbing across the cornea. This can be anything from a fingernail to the edge of a piece of paper or even the leaf of a tree or bush.

When a patient scratches or abrades the cornea, this becomes an event that the individual has to pay attention to due to the pain involved. While corneal abrasions heal very quickly under most situations (the cornea is the fastest healing tissue in the body) care has to be taken to make sure that an infection does not develop. Once the epithelium is disturbed, the cornea becomes subject to infection. The epithelium presents a barrier to bacteria and other agents that can harm the eye. Eye doctors normally protect the eye from infection by prescribing an antibiotic eyedrop to protect the eye while the cornea heals.

There are different types of abrasions that can affect the cornea. If the cause of the abrasion is something like a fingernail or mascara brush that scratches but does not embed itself into the cornea, the treatment is usually an antibiotic eyedrop and a pain control medication. If the cause of the abrasion involves something that becomes embedded in the cornea, the treatment is different as the embedded object needs to be removed. Removal involves the administration of an anesthetic eye drop and the removal of the object. If the object is on the surface the removal is relatively easy. If the object penetrates the cornea deeply this becomes a much more complicated procedure. Occasionally a metal foreign body will embed in the cornea and leave "rust" residue. The object has to be removed and sometimes the rust must be removed as well.

For large corneal abrasions where the area of the abrasion is clean of debris, a soft contact lens can be placed on the cornea to help with the healing. The soft lens is used in a theratputic fashion in this case. The soft lens becomes a "bandage" for the cornea allowing the epithelium to fill in the area of the damaged cornea and allowing the patient to be much more comfortable during the healing process.

The location of the abrasion is important as well. If the abrasion involves the area over the pupil, care must be taken to not damage the tissue as this can have a permanent effect upon vision. Surface abrasions are easily dealt with in this case, but penetrating abrasions can present a problem and permanently alter vision if the penetration is deep enough to cause a scar to the corneal area over the pupil.

The bottom line is to immediately contact your eye doctor if there is an abrasion to the cornea. While painful, the treatment is often pretty straight forward and the outcome is excellent. In the event of a more serious abrasion, the eye doctor can take the necessary steps to make sure the outcome is as good as can be expected.

Why Are Contact Lenses Medical Devices?

It seems I am constantly confronted with questions from some patients that wonder why contact lenses are considered medical devices. Many people think that contact lenses are simply commodities that should be sold over the counter and available everywhere without the requirement of a prescription. Here is an example of how patients can get into trouble if they misuse contact lenses and why they should be controlled by a prescription and only be available through doctors.

I had a patient that came in about six months ago for an eye exam. The patient had been complaining of discomfort when wearing his contact lenses. He was experiencing discharge from his eyes and redness. He also complained of blurred vision. Upon examining the patient and taking a history I learned that the patient had been given a pair of disposable one day single use contact lenses and had left them in his eyes overnight continuously for six months. The lenses were coated with mucous. His eyelids, on the underside, were significantly inflammed and there were multiple "bumps" on the underside of the eyelids (called giant papillary conjunctivitis) causing the localized mucous glands under the lids to produce even more mucous. His corneas were swollen contributing to his blurred vision and his discomfort. Basically his eyes were "a mess". I asked him why he had been using his contact lenses in this fashion and he said that he did not think there was anything wrong with his usage of the contact lenses and that it was no big deal. His friend who had the same "number for his eyes" had given him a pair and at first everything was fine. Unfortunately his problems caught up with him and yielded the result I have described above. I am not saying that this could not happen to a patient that received his lenses from a doctor. If a patient chooses to ignore the instructions and bend the rules of usage of contact lenses in spite of proper instructions from his health care practitioner, there is not much his doctor can do about it. The odds, however, are much greater that this kind of behavior will not occur if patients are instructed about what contact lenses can do and how to properly use and care for them. This patient was quite nearsighted and did not have any glasses. He had to get some emergency glasses and discontinue contacts for two months. He had to undergo treatment for his condition which involved eyedrops that were fairly expensive. After successful therapy he is now back wearing contact lenses with a much greater appreciation of what they are and how to properly care for them.

It is extrememly important for patients to understand that contact lenses are medical devices and they require proper care, handling and disinfection. They should be used according to their individual proper use instructions. Lenses that are to be worn overnight need to have a very high oxygen transmission. In additon, because they are left in overnight, they tend to become soiled quickly. It is important to not leave them in too long and to change them reqularly. There is always some increased risk when lenses are worn overnight as opposed to lenses that are used during waking hours and then cleaned and disinfected...or discarded daily as it the case with single use disposable contact lenses.

If a patient has any questions about proper contact lens care it is best for them to contact their eye doctor to make sure they are using their lenses in the proper manner.

My Son The Doctor

I can't tell you how great it is to practice with your child. It was something that I had sort of given up on based upon the initial reaction of my children when I first broached the subject. When my children were much younger I invited both of them to consider optometry as a career. They both answered without hesitation: "No!" My son is the eldest of my two children and he wanted to be involved in the movie business. He initially wanted to write and produce movies. He majored in English when at UCLA and received his degree in that field. My daughter studied business and graduated with a double major at SMU in business and Spanish. She worked in a business climate for a couple of years and then decided that teaching was what she really liked. She received her credential and she now teaches at a private school in Santa Monica, California. She does all of this including being a mother to her wonderful family which includes her attorney husband, Marcos and her two children, Molly and Matthew.

My son initially worked for a few production companies and did some acting. After a few years of doing this he felt he was not going in the right direction. He then sold life insurance for a major insurance company, but did not really like doing it. After about a year of working in the insurance business, he came to me and asked if I was still interested in him going into the field of optometry. I said that I definitely was, and off he went.

This was no easy task as he had been an English major. He was a natural at writing and really loved it, but he had always taken the path away from math and science. Now he had to go back and take all the classes that he had initially avoided. He had to get good grades in the subjects and he had to take an entrance exam for optometry school. He did all of this and was accepted into a great school. While in school he met a terrific young lady who was also in optometry school and they are now married and both practice with me at Village Eyes Optometry in Westwood Village, California.

It is terrific to have these young and energetic doctors to practice with. We frequently discuss mutual cases and we are always talking about our field of optometry. At family outings, everyone knows to avoid us because we will almost always be discussing eyeballs in one sense or another. For me this is fun and challenging. It is a real pleasure to see them working so hard and enjoying what they do.

We have a wonderful family practice at Village Eyes Optometry. All five doctors get along extremely well and we all interact with our terrific staff and appreciate one another. My wife, Sissy, also works at the practice and takes care of all the daily business requirements that are needed to keep our business on track. For me, it's as good as it can get. I am looking forward to many more years of practice with my son, my daughter-in-law, and the rest of our optometric family.

Contact Lenses for Surfing

Contact lenses for surfing and water sports have come a long way over the last several years. Regardless of how high a person's prescription is, it is probably possible to construct a soft contact lens for that person to use in water sports. Most prescriptions can be formulated in a disposable contact lens prescription. Those that cannot are still availble in a custom form that is compatible with water sports. It is possible to construct a lens that is larger than normal for water sports. This allows the lens edges to tuck up under the eyelids creating a more stable lens design.

While it is still possible for a surfer to have a big wipe out and occasionally lose a lens, this is the exception rather than the rule when contact lenses are used for surfing. If a lens is lost, it is usually on just one side. This allows usable vision to return to shore and either get another lens or call it a day. There are also certain disposable lens designs that are bigger than average and lend themselves to water sports.

There is another alternative to vision correction that can work quite well for patients that have a correction up to -5.00 and even higher. This is known as "orthokeratology". In orhtokeratology, special rigid contact lenses are applied to the eyes to be worn at night (although they can be used during the day as well)and the lenses reshape the cornea to the point that the vision is good enough to be able to function in the water (and during the day in normal activities)so that no contact lenses are required after the lenses are removed from the eyes. This is an obvious benefit for surfing as it eliminates the contact lens loss factor.

The best way for interested surfers to explore these contact lens possibilities is to visit an eye doctor that has experience in fitting custom contact lenses. If the reader of this blog has any questions regarding these options I am willing to discuss them on an individual basis. My email is: jon@villageeyes.com.

Blepharitis

Here is an excellent description of blepharitis describing the condition and how to treat it. The following is a link to the article:

Blepharitis

Surfer's Eye Problems

This entry will focus on issues that specifically confront surfers, but it could also apply to anyone that spends a great deal of time in the sun without adequate eye protection.

The problem that confronts surfers is related to their eye exposure to the sun and wind and the non-use of sun protection due to the water based nature of the sport. Sun protection does exist for surfers, but it is rarely used while in the water. This is due to the difficulty of keeping the protective eyewear on the head securely while surfing large and powerful waves. Even smaller waves have the potential, if the surfer "wipes out", to cause the wearer to lose the eye protective product. There is also the issue of the lenses "fogging up" as well as water droplets collecting on the surface of the lenses resulting in obscuring the vision.

It still would be better if surfers could wear eye protection. This would help prevent the occurence of various conditions that are commonly associated with sun exposure. Here are some of the conditions that are frequently seen among surfers as well as individuals that spend a great deal of time in the sun: 1. The pinguecula. This is a growth on the side of the cornea..typically in the 9:00 or 3:00 positions, that can either be caused by sun and wind exposure or can be aggravated by the exposure. These growths are elevated from the underlying white part of the eye. In so much as they are elevated, they are more prone to drying out as well as exposure. When they become irritated they can become red and can cause the eye to feel dry or "scratchy". In years past there was no recommended treatment for the pinguecula. Now there are improvements in surgical techniques that make their removal possible. If a pinguecula is irritated, relief can be obtained by the usage of artificial tears. The best artificial tears are of the non-preserved variety. Sometimes an anti-inflammatory medication can help make the eye more comfortable. 2. The pterygium. This is a growth in more of less the same area as the pinguecula, but in this case the growth actually is onto the cornea. The same conditions can cause and contribute to this problem, but the irritation can be more serious. In addition, should the pterygium grow to a large enough dimension, there is the possibility that it can impair the vision. Typically, the growth can induce an increase in astigmatism. The pterygium can also be treated by surgery. There is a risk that the pterygium can return after surgery. As a result, once surgery is performed, the patient must do everything possible to protect the eyes from sun and wind. The non-surgical treatment for the pterygium is basically the same as for the pinguecula (artificial tears and anti-inflammatory medications). 3. Solar Keratitis. This refers to an actual sunburn of the white part of the eye and the cornea. This is due to extreme sun exposure. This could occur, for example, if a patient were to spend a day skiing without wearing sunglasses. The condition is quite painful. While painful and uncomfortable, the condition is usually not serious and will abate over a short period of time. Artificial tears help to offer some relief. The patient can feel temporarily blinded by this condition as the cornea will become cloudy due to the irritation and swelling that accompanies the sun exposure. 4. Cataracts. There is a definite causal relationship between sun exposure and cataract formation. While everyone will eventually get cataracts if they live long enough (they are a normal aging change in the eyes), they can be brought on much sooner due to sun exposure. Again, sun protection is helpful in halting or slowing down cataract formation.

What can a surfer do to help avoid these conditions? The best way to protect the eyes is sun protective eyewear. There are a number of companies that make eyewear to protect the eyes even when in the water. Unfortunately, not all surfers are willing to wear the sun protection. It is also possible to wear a visor while in the water. This will protect from the sun getting directly into the eyes, but it will not really deal with reflected glare off of the water. There are also available certain types of contact lenses that offer some UV protection. The issue here is that while there is UV protection to the cornea the white part of the eye is still exposed. Again, sun protective eyewear is the best solution.

Patients that have to wear eyeglasses to see clearly can now use contact lenses when in the water doing various water sports. There are a number of products available. Many offer UV protection.

The best way for a surfer or avid outdoor enthusiast to find out how to protect their eyes is to visit their eye doctor. An eye doctor can custom tailor a treatment plan that will best suit the patient.

Dear Readers: I invite you to follow my blog!

I want to thank all the readers that have taken the time to view my blog. I also invite readers to make any comments that they feel are relevant in the comment section at the bottom of the various entries. In addition, if there are any subjects that an individual reader would like to be discussed in the blog, please let me know. I invite all readers to become followers of my blog. It is very easy to do so. Just click on the "Follow" icon and follow the prompts. By becoming a follower and a "fan" this allows readers to easily share the information that I have posted with their friends,families and associates.

Thanks again,

Dr. Jon

Blurred Vision: Should I Be Concerned?

Blurred vision is a major complaint of patients that come to Village Eyes Optometry. There can be several causes of blurred vision. Some of them are not serious and some of them can be very serious. It is up to the eye doctor to determine the cause of the blurred vision, the best remedy, and the necessity of any medical intervention should the blurred vision be due to a serious medical problem.

Here are some common causes of blurred vision:
1. Nearsightedness, farsightedness and astigmatism. These are probably the most common causes of blurred vision. The solution is to prescribe the proper eyeglasses or contact lens prescriptions to solve the problem.
2. Computer usage. In this case the eyes can become blurred due to long term looking at a computer screen. This can occur even if the patient does not have a condition such as nearsightedness (myopia), farsightedness (hyperopia), or astigmatism. The eyes can become dry and this can also contribute to blurred vision.
3. Eye muscle problems. Here the eyes can become blurred as they compensate for the inability of the eye muscles to point properly at the desired reading material.
4. General fatigue. If a person is physically tired, their vision can become blurred.
5. Medications. Certain medications can contribute to blurred vision. The eye doctor needs to take a well documented case history to make sure that a medication that the patient is taking is not causing the blurred vision.
6. Medical conditions affecting the eyes. There are a number of systemic conditions as well as localized eye medical conditions that can cause blurred vision.
Multiple Sclerosis, Graves Disease, Myasthenia Gravis, Muscular Dystrophy, Diabetes, and Hypertension are just a few of the systemic diseases that can cause blurred vision. Withing the eye itself, several conditions can cause blurred vision such as cataracts, dry eyes, glaucoma, corneal problems such as keratoconus, problems with the iris such as iritis, problems with the vitreous (the middle part of the eye), eye floaters, and problems with the retina. The retina can cause all sorts of blurred vision problems such as macular degeneration and macular edema.

These are just an overview of the various issues that can lead to blurred vision. The most important thing to do is to see your eye doctor when you experience blurred vision. Your eye doctor will be able to determine if the cause of your blurred vision is something simple or is a more complicated matter requiring more involved treatment.

Internet or "Squinternet"?

Has the internet become the "squinternet"?

What I mean by this is that usage of the computer for hours at a time to access the internet, do social networking, surf, etc. has placed tremendous demands upon our eyes. This has caused a great deal of problems for those that participate. The various issues that patients confront can vary from eyestrain, headaches, blurred vision, double vision, neck ache, as well as pain to the wrists and forearms, numbness etc.

The way we often react with our eyes to difficulty in focusing or eyestrain is by squinting. Hence, the "squinternet".

So how do we best deal with these issues? Here are some suggestions:

1. Without being self serving the first thing I recommend is that you see your eye doctor and get an eye exam. Make sure that your prescription is correct for you and that it best represents what you specifically need to be able to focus on the computer screen. This may sound simple but it can be complicated. Your screen is at one distance and the keyboard is at another. You may be using different computers at work and at home. The distance for you to focus on a lap top is different from a desk top. All of these issues can affect how you focus and how you use your eyes when on the computer. Some patients need different pairs of glasses depending upon where they are working at the time. Some patients only need simple reading glasses. Your doctor will be able to determine the best approach for you. When you go in for your appointment it is very helpful if you can bring in data that accurately describes how far you sit from the various screens that you are working on. Assume your normal position in front of the screen and have someone measure the distance from the screen to your eye and the distance from the keyboard to your eye. This will help the doctor to best prescribe for you. New lens products have been recently introduced that provide tremendous help for computer users. There is a new progressive multifocal available that has in the center of the lens a large area designed to focus on the screen distance. In the top of the lens is a smaller distance viewing area and in the bottom of the lens is more magnification for small text. This allow the computer user to have a large "sweet spot" for their computer viewing and also see distances as well as up close for text viewing. There are also greatly improved glare free coating that allow more light to get into the eyes.

2. Glare can be a big problem for computer users. It is best to have your computer in an area where you will not have an open window in front of you as you view the screen. It would be better to position the screen, if you can, with the window behind you or off to the side. If you cannot accomplish this you can use blinds or drapes to cover the window. Many patients are bothered by overhead glare from overhead light sources. In the case of flourescent lighting, it can be helpful to remove some to the "tubes" to cut down on the amount of light upon the screen. It can also be helpful to wear a hat or visor to cut down on the glare from above. If reflections from the screen are an issue, make sure that the screen is as clean as possible. The new flat screens are a big improvement. It is also possible to make a "bonnet" for the screen itself. Take a piece of cardboard and cut it so it will fit over the computer screen and extend out five or six inches. You can tape it to the back of the screen with duct tape. This will get that overhead glare off of the front of the screen.

3. Sit at a distance that allows you to see the screen without leaning forward. If you lean in this will take a toll on your neck and back. Make sure that your chair has good back support. Pillows are available to give you better lumbar supprot. In an ideal situation, the screen is supposed to be slightly below eye level. If you can make this happen this is great. If you cannot, make sure you discuss the positioning of the screen with your eye doctor.

4. Sometimes, the difficulty a patient has with their vision is not just focusing but has to do with the ability of the eyes to point together at the screen distance for an extended period of time. If a patient has difficulty in this area, exercises can be prescribed to strengthen the eye muscles that allow us to point our eyes at the appropriate distance. Exercises can also help relax the eyes and strengthen them to help with focusing between distance and near. Eye doctors talk about the 20/20/20 rule. This pertains to taking the time to relax your eyes regularly by looking away from the screen every 20 minutes for 20 seconds and blinking 20 times. This accomplishes several things: Looking away stretches the muscles in the eyes allowing them to relax after looking up close for a long period of time. Physically, it allows the computer user to get back from the screen and to also relax the neck muscles, shoulder muscles, etc. Blinking rewets the tissues of the eyes and makes eyes more comfotable.

5. Dryness of the eyes is a common complaint among patients using the computer. Following the 20/20/20 rule above will help. Here are some other suggestions: Drink enough water. Blink more in general: To accomplish this take a "post it" and write the word blink on it. Stick it on the computer near the top. When you see this during the day make sure that the blink you make is a full blink. Research has shown that our blink rate goes way down on the computer...by as much as two thirds. This contributes to dryness, burning and general visual discomfort. Blinking more really helps. It is also helpful to have some wetting drops by the work station. Not all wetting drops are the same. Your eye doctor will make a recommendation for the drops that best suit your particular needs. In general, the best drops are those that are non-preserved. They are a little more expensive, but the preservatives that are in over the counter eyedrops can cause problems and irritation that can be avoided by using the non-preserved variety. Severe dryness problems require more attention and a more complicatead solution than can be provided by eyedrops. Your eye doctor will be able to help you if your are still experiencing dryness even when using eyedrops or in spite of having tried the above suggestion.

I hope these suggestions have been helpful. Please visit your eye doctor for a thorough evaluation of your computer vision needs and keep the internet from becoming the "squinternet".

Optometrists Ophthalmologists & Opticians (The Three O's)

I am an optometrist and I have been in practice in Westwood Village, a suburb of West Los Angeles, since 1971. Patients will still refer to me as an ophthalmologist or optician from time to time. I think the reason that there is confusion among the public is due to the fact that there is a great deal of overlap in terms of what the three professions provide. All are involved with various aspects of vision care. In addition, the definition of optician and optometrist varies from country to country. In some countries, optometrists can only refract (test vision) and provide eyeglasses and contact lenses. They can not treat eye diseases or do eye health evaluations. Opticians can refract in some countries and not in others. In the United States, opticians can fill prescriptions for eyeglasses and contact lenses but they cannot refract and test vision. Optometrists in the United States can treat eye infections, dry eyes, eye allergies, and eye diseases as well as test vision and refract. This has not always been the case. When I graduated from optometry school optometrists did not have the ability to treat eye diseases. We were trained to detect them, but we always had to refer out to a medical doctor when we detected a medical problem. If the problem was an eye problem, we would refer to the appropriate ophthalmologist. If the problem was with a general medical condition such as hypertension or diabetes, we would refer to an internal medicine specialist or general practitioner.

Things have changed over the years. The scope of practice of optometry has expanded. The laws that govern the practice of optometry have changed over the years to include the treatment of eye diseases and eye medical problems. This has occurred on a state by state basis. Here in California, once optometrists were granted an increased scope of practice, they had to take and extended number of additional hours of specialized education and pass a comprehensive examination. In addtion, they had to work side by side with ophthalmoligists according to a schedule specified by the state Board of Optometry before they could begin utilizing their new skills. Optometrists can now treat eye diseases such as glaucoma. We can treat eye infections and eye allergies as well as dry eyes. This increased treatment capability was originally only available within the realm of ophthalmology. If optometrists do detect or diagnose a problem that is beyond our expertise, the patient is referred to the appropriate medical practitioner.

Optometrists are well connected with the best medical specialists in their respective areas. Patients that are referred out for specialty care are then referred back to the referring optometist for continued care. This is called "co-management".

So, is it still confusing for patients to understand the difference between "The Three O's"? The answer is probably yes. Due to the overlap of services that is frequently provided is is only normal that patients can confuse "The Three O's". It is up to the optometrist, the ophthalmologist and the optician to fully explain the services that can be offered to their patients.

Eye Exams and Eye Doctors: What to Expect

Here are some comments about Eye Exams and Eye Doctors that pertain to patient visits at our office in West Los Angeles, Westwood Village, California.


Patients can be very apprehensive about their eyes when they visit their eye doctor. It is important to choose an eye doctor that takes the time to listen to your symptoms and prescribes the best mode of vision correction for the individual patient. If the visit is for a yearly eye examination this visit is really like a physical for your eyes. Eye health is tested frequently via a dilation of the eyes. Eye muscle coordination is tested as well. The eye is looked at from the front all the way to the back. The eyes are tested for glaucoma and evaluated for dryness and signs of allergies. A prescription is determined by a process known as a refraction. It is important that the doctor is as accurate in determining the prescription as is possible. Once all the information is gathered, the doctor will make recommendations as to the best way to treat the patient's individual vision problem. The recommendations can be anything from a single vision lens for either distance or near to a multifocal correction. Often the doctor will recommend sunglasses to block out the sun's harmful rays. In addition, reflection free coatings are often prescribed to help allow more light get into the eye and provide the clearest vision possible. At times the solution will involve eye exercises instead of eyeglasses. The correction can also include contact lenses. If contact lenses are desired it is best to choose an eye doctor that has a great deal of experience in contact lens fitting. This will provide the patient with the most favorable outcome.

The above description relates to routine yearly eye exams. Of course, there are urgency and emergency visits as well. Here the visits are confined to a problem solving situation, depending upon the problem that the patient faces. Eye infections are treated with the necessary medications. It is important for the doctor to determine the exact cause of the problem and prescribe the correct therapy. Eye allergies can often be treated with anti-histamine eye drops. Dry eyes can present a perplexing problem. The cause of the dry eyes must be determined. In addition, there can be issues with tear quality that can often compromise eye comfort. The doctor must not only deal with the dry eye issues but must make sure that the tear film is as normal as possible. Again, it is best to choose a doctor that has lots of experience with these issues.

Yellow Growths on the Sides of the Eyeball

I am frequently asked by patients about a yellow/whitish/sometimes glistening growth on the sides of the eyeball. Typically these growths are at the 3:00 and 9:00 positions to the side of the colored part of the eye. There are two official descriptions for theses growths.

The first description applies to when the growths are only on the white part of the eye. In this case the growth is called a pinguecula. These growths are thought to be more common in individuals that spend alot of time outdoors. Here are a few examples: Farmers, gardeners, skiers, surfers, lifeguards, people living in tropical climates, and people who spend a lot of time outdoors and do not used any sun protection. The pinguecula is not a serious problem, but it can be irritating to the patient as the growth is elevated compared to the other parts of the eye. Because it is elevated, it is more exposed to wind, sun, irritation and it can dry out earlier. Pingueculas can become reddened when irritated and can become cosmetically unpleasing.

The second description of the yellow growths applies to when the growth actually grows onto the cornea (the clear "window" that covers the colored part of the eye...the iris). In this case the growth is described as a pterygium. The causes of the pterygium are the same as with the pinguecula. It is just a farther advanced case of the tissue growth. When the tissue grows onto the cornea it can become more irritating and red. It also becomes more cosmetically unacceptable as it is red and uncomfortable most of the time. There is a risk that the pterygium could grow far enough on the cornea that it could cause some loss of vision. This can be prevented by seeing an eye doctor early enough to take care of the problem before it becomes too serious.

Not all pingueculas become a pterygium. It depends upon many factors. It is important to realize that if you have a pinguecula there is a risk that it could become a pterygium. The best way to avoid the change is to protect the eyes from the sun and wind. The patient should wear good quality sun protection when outdoors and wear a hat for extra protection.

Both pingueculas and pterygia can be surgically removed if necessary. This can best be achieved by an ophthalmologist that is a corneal specialist. If you have any questions or would like the names of corneal specialists that I work with please email me at jon@villageeyes.com.

If you have any questions please contact your eye doctor for a thorough evaluation.

What Makes a Disposable Contact Lens Disposable???

I remember when I first started to practice and the only contact lenses we had were hard contact lenses. Then along came soft contact lenses in 1971. The first soft contact lenses were designed to be kept for a long time.....at least a year. A few years thereafter the first disposable contact lenses came along. They were initially not very good. Technology improved and today the majority of soft contact lenses that are dispensed are of the disposable variety. Custom soft contact lenses are still being made, but they are often used for specialty purposes. Todays disposable soft contact are excellent. But, what makes a contact lens disposable and why do patients need to consider them?



Technically all contact lenses are actually disposable. The yearly ones are disposable except that you dispose of them yearly. Todays disposable soft contact lenses come in a wide variety of options. There are quarterly, monthly, bi-weekly and daily disposable contacts available. Patients that have eye allergies, very sensitive eyes, dry eyes, etc. often do better changing their contact lenses more frequently. This could mean every day. This is perfect for a daily wear disposable. Daily wear disposable lenses also lend themselves easily to part time wear. Let's say you just want to wear them for sports. O.K. Put on your daily single use contacts and go for it. When the activity is over...just toss them!

Weekly and Bi-weekly disposable soft contact lenses are also very popular. They come in a wide variety of materials. In my office, I prefer the monthly lenses in many cases. This product is easy to maintain and it is always easy to remember when to change the lenses.....new month: toss the old ones and open another pair. The plastics that the lenses are made from is constantly improving. Todays materials are so permeable that, in terms of oxygen transmission, it is almost like a lens is not on the eye.

Because the care of contact lenses has become easier and the product can be purchased in a wide variety of locations including on line sources, patients often forget that soft contact lenses are medical devices. This means that when used properly they are safe and effective, but patients must pay attention to their eyes and seek regular eyecare to make sure that they are not having any negative consequences from their contact lens wear. The safest modality for contact lenses is "daily wear". This means that each day the lens is placed upon the eye and worn for that day. At the end of the day the lens is removed and either discarded (as is the case with single use disposable contacts) or cleaned and disinfected so it can be worn the next day.


The disinfecting systems have gotten better over the years too. Originally, the only system for disinfecting the old style soft contacts was by heating them. Patients had to make their own saline solution using distilled water and salt tablets. We have come a long way since then. Now several companies make multipurpose disinfecting systems that make the care of the lenses much easier. Patients should always thoroughly wash their hands before touching their eyes or working with their contact lenses. The key, when using these multipurpose disinfecting systems, is to make sure that each day the lenses are rubbed between the fingers or in the palm of the hand with fresh disinfecting/cleaning solution. In addition, the old solution should be discarded and fresh solution should be added. The case should be cleaned and air dried every week. The case should be changed every few months to make sure it is clean and functioning properly. There is another system that I like that relies on hydrogen peroxide to disinfect the lenses. This system is especially helpful for patients with sensitive eyes and those that have an abnormal amount of protein in their tear film.

Soft contact lenses can be enjoyed for either full time or part time wear. They offer an excellent way to have an alternate system for vision correction. They are great for sports, social activities and general wear. They come in a wide variety of options including single vision, astigmatism correcting (toric) and even multifocals. They can be used for daily wear or extended wear (leaving them in overnight). The key for patients is to recognize that the lenses are a medical device and need to be evaluated on a regular basis. It is best to see you eye doctor to ensure that you are a good candidate for contact lens wear and for regular maintenance of the contact lenses.

Blood In The Eye

When you look at your eye and see blood in the white part of the eye, this is called a "sub-conjunctival hemmorhage". This can occur in response to trauma or it can even occur randomly. Most of the time, especially if the hemmorrhage occurs in a random fashion, this is a painless event. It is not uncommon for a patient to wake up in the morning feeling normal until the patient looks in the mirror and sees the blood. This naturally becomes a cause of concern.

Here is what happens: The white part of the eye is called the sclera. It is covered with a thin and transparent membrane called the conjunctiva. Below and within the conjunctiva are many small blood vessels that have a diameter about the size of the point of a pin. It does not take much to rupture these vessels as they are very delicate. Once ruptured, the blood has to go somewhere so it spreads out until our system causes the blood to clot and the bleeding stops. Once the bleeding stops, gravity takes over and some of the blood just drains downward as well as outward. Our lymphatic system gets rid of this blood over time....it takes up to two + weeks depending upon the amount of blood collected. The last part of the eye to clear of the blood is the part nearest to the colored part of the eye as the cornea does not have any lymphatics. Drops designed to "get the red out" won't do anything...they are designed to shrink dilated blood vessels that are engorged due to inflammation. This blood lies below the surface and it takes time for the blood to go away.

The causes can be from any cathartic event...sneezing, coughing, straining, heavy lifting, etc. It can also occur randomly without the above causes. Patients taking blood thinners can be more likely to experience the event. The event can also occur more frequently if the blood pressure is elevated. The best way to be sure of the cause and to make sure that your eyes are healthy is to see your eye doctor when the event occurs and to have your blood pressure tested.

Eye twitching

Eye twitching is a very common complaint voiced by my patients at our West Los Angeles office. Patients report irregular and random twitching of the upper and lower eyelids. Typically, the patient feels the twitch and looks in the mirror and cannot see that much movement in the eyelids. So, why is this happening and what are the causes and the treatment???

The technical description for this is "myokymia". In most cases it is due to a muscle fiber in the eyelid just randomly firing. This creates the twitch. This is the same phenomenon that occurs when you are sitting down and notice a twitch in a muscle of the legs. There are these twitches ongoing all over your body most of the time, but they are usually not noticed. When this happens in your eyelid it is more noticeable.

The causes of this condition have been attributed to stress, need for a new eyeglasses prescription, eyestrain, not getting enough sleep, drinking too much coffee and on and on. What can you do to stop the twitching? Most of the time the twitching stops after a period of time. I remember having the problem and having it last almost a month before it stopped. This is quite common. There were some reports that using a topical antihistamine eyedrop was helpful, but I have not seen this documented lately. The most important thing is to not worry about an eyelid twitch, but to have your eyes examined to make sure that your eyeglasses prescription is correct and to rule out any more serious causes.

The eyelid twitch is not to be confused with a blepharospasm. In the blepharospasm, there is a forced closure of the eyelids. This is a more serious and more troublesome event. The bottom line: Get checked out by your eye doctor if you have any of these symptoms.

Myopia Treatment & Bifocals for Children

There was an article in the Los Angeles Times today reporting about a new study that was just completed that will be published in the Archives of Ophthalmology. The article discusses the increase recently noted in myopia and a possible treatment for myopia.

There are several theories about the cause of the increases in myopia, but most of them hint at a causal relationship between all close work children are doing and the myopia increase. Kids are playing video games, watching television, using a computer and looking at their telephone displays. On top of that they have their homework and whatever pleasure reading they may do. This all amounts to lots of close work.

The article reported on the treatment of myopia with bifocals. The theory is that the bifocals allow the children to read through a lesser powered part of the lenses....basically this is what happens in a bifocal design...and thereby they are not having to focus as much when they do their close work. The kids that used the bifocal eyeglasses had a 38% decrease in their myopia compared to the group that used traditional single vision distance only eyeglasses.

In addition to the usage of bifocal eyeglasses, it should be mentioned that it is possible to treat children that are myopic with contact lenses that are bifocals as well. I have done so in my practice and found that myopia changes have been less in children that use their contacts in this manner. This can be done with soft lenses as well as rigid gas permeable contact lenses.

There is also a technique, known as orthokeratology, in which special contact lenses are fitted to the corneas to be worn at night. This technique causes the cornea to flatten overnight. When the lenses are removed the nearsightedness improves significantly.

While all of this is still relatively controversial, there is increasing evidence that points to the fact that these different approaches can help retard the deveolpment of myopia. Make sure that you discuss all this when you next bring your children in for their yearly eye exams.

Eye Exams for Children

As a parent, you may wonder whether your pre-schooler has a vision problem or when a first eye exam should be scheduled.
Eye exams for children are extremely important. Experts say 5 percent-10 percent of pre-schoolers and 25 percent of school-aged children have vision problems. Early identification of a child's vision problem is crucial because, if left untreated, some childhood vision problems can cause permanent vision loss.

When should kids have their eyes examined?

According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. Children then should receive additional eye exams at 3 years of age, and just before they enter kindergarten or the first grade at about age 5 or 6.
For school-aged children, the AOA recommends an eye exam every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or according to their eye doctor’s recommendations.
Early eye exams also are important because children need the following basic visual skills for learning:
Near vision
Distance vision
Eye teaming (binocularity) skills
Eye movement skills
Focusing skills
Peripheral awareness
Eye/hand coordination

Because of the importance of good vision for learning, some states require an eye exam for all children entering school for the first time.

Scheduling your child’s eye exam:

Your family doctor or pediatrician likely will be the first medical professional to examine your child's eyes. If eye problems are suspected during routine physical examinations, a referral might be made to an ophthalmologist or optometrist for further evaluation. Eye doctors have specific equipment and training to help them detect and diagnose potential vision problems.
When scheduling an eye exam, choose a time when your child is usually alert and happy. Specifics of how eye exams are conducted depend on your child's age, but an exam generally will involve a case history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, an eye health examination and a consultation with you regarding the findings.
After you’ve made the appointment, you may be sent a case history form by mail, or you may be given one when you check in at the doctor's office. The case history form will ask about your child's birth history (also called perinatal history), such as birth weight and whether or not the child was full-term. Your eye doctor also may ask whether complications occurred during the pregnancy or delivery. The form will also inquire about your child's medical history, including current medications and past or present allergies.
Be sure to tell your eye doctor if your child has a history of prematurity, has delayed motor development, engages in frequent eye rubbing, blinks excessively, fails to maintain eye contact, cannot seem to maintain a gaze (fixation) while looking at objects, has poor eye tracking skills or has failed a pediatrician or pre-school vision screening.
Your eye doctor will also want to know about previous ocular diagnoses and treatments involving your child, such as possible surgeries and glasses or contact lens wear. Be sure you inform your eye doctor if there is a family history of eye problems requiring vision correction, such as nearsightedness or farsightedness, misaligned eyes (strabismus) or amblyopia (“lazy eye”).

Eye testing for infants:

It takes some time for a baby’s vision skills to develop. To assess whether your infant's eyes are developing normally, your eye doctor may use one or more of the following tests:
Tests of pupil responses evaluate whether the eye's pupil opens and closes properly in the presence or absence of light.
“Fixate and follow” testing determines whether your baby can fixate on an object (such as a light) and follow it as it moves. Infants should be able to perform this task quite well by the time they are 3 months old.
Preferential looking involves using cards that are blank on one side with stripes on the other side to attract the gaze of an infant to the stripes. In this way, vision capabilities can be assessed.
Eye testing for pre-school children
Pre-school children can have their eyes thoroughly tested even if they don’t yet know the alphabet or are too young or too shy to answer the doctor’s questions. Some common eye tests used specifically for young children include:
LEA Symbols for young children are similar to regular eye tests using charts with letters, except that special symbols in these tests include an apple, house, square and circle.
Retinoscopy is a test that involves shining a light into the eye to observing how it reflects from the retina (the light-sensitive inner lining of the back of the eye). This test helps eye doctors determine the child's eyeglass prescription.
Random Dot Stereopsis uses dot patterns to determine how well the two eyes work as a team.
Eye and vision problems that affect children
Besides looking for nearsightedness, farsightedness and astigmatism (refractive errors), your eye doctor will be examining your child’s eyes for signs of these eye and vision problems commonly found in young children:
Amblyopia. Also commonly called “lazy eye,” this is decreased vision in one or both eyes despite the absence of any eye health problem or damage. Common causes of amblyopia include strabismus (see below) and a significant difference in the refractive errors of the two eyes. Treatment of amblyopia may include patching the dominant eye to strengthen the weaker eye.

Strabismus. This is misalignment of the eyes, often caused by a congenital defect in the positioning or strength of muscles that are attached to the eye and which control eye positioning and movement. Left untreated, strabismus can cause amblyopia in the misaligned eye. Depending on its cause and severity, surgery may be required to treat strabismus.

Convergence insufficiency. This is the inability to keep the eye comfortably aligned for reading and other near tasks. Convergence insufficiency can often be successfully treated with vision therapy, a specific program of eye exercises.

Focusing problems. Children with focusing problems (also called accommodation problems) may have trouble changing focus from distance to near and back again (accommodative infacility) or have problems maintaining adequate focus for reading (accommodative insufficiency). These problems often can be successfully treated with vision therapy.

Eye teaming problems. Many eye teaming (binocularity) problems are more subtle than strabismus. Deficiencies in eye teaming skills can cause problems with depth perception and coordination.

Vision and learning:

Experts say that 80% of what your child learns in school is presented visually. Undetected vision problems can put them at a significant disadvantage. Be sure to schedule a complete eye exam for your child prior to the start of school.

The above article is credited to "All About Vision". The link to their web site is: www.allaboutvision.com.

Dry Eyes: Causes and How to Treat

Dry eyes can be a very challenging and uncomfortable problem for those patients that suffer with this condition. Dry eyes can sometimes be a mild problem that only causes inconsistent discomfort. On the other extreme it can be severly debiltating causing blurred vision, constant discomfort, and even eye pain. Dry eyes can even make the patient more susceptible to eye infections.

The causes of dry eye can be physical as well as environmental. Some patients just do not make enough tears. Tears are primarily created in a gland that sits just above the outside part of the eye and behind the bone that sits above the eye. This gland is called the "lacrimal gland". With age this gland produces fewer tears. There are other sources of tearing, called accessory lacrimal sources, but the majority of tearing comes from the lacrimal gland. It is confusing for patients to be told by their eye doctors that their eyes are dry when the primary complaint that is often offered to their eye doctor is that their eyes often tear or "water" at the end of the day or in the morning or during certain tasks. Here's what's happening: There are two types of tearing that patients encounter. The first is the normal slow and constant tearing from the lacrimal gland that keeps the tissues of the eye lubricated. If this mechanism is working there is normally not an issue with dry eyes. If there is not sufficient lacrimation from the lacrimal gland this causes the tissues of the eye to dry out. This results in dry and irritated eye tissues which causes the eyes to produce a reflexive amount of tearing in response to the irritation which yields a great deal of tears in response to the irritation. A similar abundance of tears occurs when we respond to something that makes us cry because we are saddened or are extremely happy. This excessive tearing is what causes the watery eyes that often bother patients when working on a computer at the end of the day.

The key to keeping the eyes comfortable and normally hydrated is to make sure that the slow constant tearing from the lacrimal gland is maximized. This can present as a real challenge due to many factors. Certain medications cause the eyes to be drier than normal. Certain activities increase eye dryness....especially using a computer...because our blink rate is significantly reduced. Climate can play a role as well. Working indoors in an air conditioned environment can contribute to eye dryness as the air conditioning system pulls water from the air. Not drinking enough water can also contribute to eye dryness.

In addition to the amount of tears that our eyes produce it is important that the quality of the tears is proper. It is important for the eye doctor to not only work to increase the amount of tears that are produced, but to make sure that the quality of the tears is such that there are no inflammatory components in the tear film.

Luckily there are a number of things that can be done to improve tear quantity and tear quality. Sometimes all that is needed is a simple eye drop. If using eye drops on a consistent basis it is important for the drops to be of the "non-preserved" variety. The preservative that is often included in over the counter eyedrops can often cause irritation if used on a long term basis.

Other techniques involve the use of "puntal plugs". These are tiny plugs that are easily inserted into the inside areas of the eye lids. These plugs "dam up" the eye and capture your tears before they can drain away. We have all had the experience of crying and then having to "blow our noses" in response to the tearing. The excess tearing causes some of the tears to spill over onto our face. In addition, some of the tears drain away into an area in the back of our nose through passages that connect this area with the openings in our eyelids that I have mentioned above. It is these openings in the inside area of our eyelids that are "plugged" to "dam up" the eyes. The plugs can be inserted in a simple painless procedure that takes about ten minutes per eye. It is important that the tear quality be good before plugs are inserted. If the plugs are inserted and the tear quality is not good, this can lead to further inflammation and irritation. There is also a medication that can be used to increase tear production. The product is called "Restasis". It consists of topically applied cyclosporin and it is dosed twice a day. This product can be used in conjunction with contact lens wear.

Please contact your eye doctor if you have any issues with dry eyes. Several treatment options exist and your eye doctor can determine the best treatment options for you. Solving dry eye problems can lead to greater eye comfort, healthier eyes, and to more successful contact lens wear.